Drug Facts - Prescription Drugs

Overview

The non-medical use or abuse of prescription drugs
remains a serious public health concern. According
to the National Institute on Drug Abuse's (NIDA)
research report
Prescription Drugs: Abuse and Addiction,
there are three classes of prescription drugs that
are most commonly abused:

opioids, which are most often prescribed to
treat pain—examples include: codeine, oxycodone
(OxyContin and Percocet), and morphine (Kadian
and Avinza);

central nervous system (CNS) depressants,
which are used to treat anxiety and sleep
disorders—examples include: barbiturates (Mebaral
and Nembutal) and benzodiazepines (Valium and
Xanax);

stimulants, which are prescribed to treat
the sleep disorder narcolepsy, attention-deficit
hyperactivity disorder (ADHD), and
obesity—examples include: dextroamphetamine
(Dexedrine and Adderall) and methylphenidate
(Ritalin and Concerta).

Many Americans benefit from the appropriate use of
prescription pain killers, but, when abused, they
can be as addictive and dangerous as illegal drugs.
Prescription drugs should only be taken exactly as
directed by a medical professional.

The Synthetic Drug Control Strategy addresses the
extent of and problems associated with prescription
drug abuse. Prescription drugs account for the
second most commonly abused category of drugs,
behind marijuana and ahead of cocaine, heroin,
methamphetamine, and other drugs. Prescription drug
abuse poses a unique challenge because of the need
to balance prevention, education, and enforcement,
with the need for legitimate access to controlled
substance prescription drugs.

Extent of Use

Data from the National Drug Intelligence Center's
2006 National Drug Threat Survey (NDTS) reveal that
78.8% of state and local law enforcement agencies
reported either high or moderate availability of
illegally diverted pharmaceuticals.

According to the 2008 National Survey on Drug Use
and Health (NSDUH), approximately 52 million
Americans aged 12 or older reported non-medical use
of any psychotherapeutic at some point in their
lifetimes, representing 20.8% of the population aged
12 or older. Approximately 6.2 million Americans
aged 12 or older reported current (past month) use
of psychotherapeutic drugs for non-medical purposes,
representing 2.5% of the population. In this report,
psychotherapeutics include any prescription-type
pain reliever, tranquilizer, stimulant, or sedative
but do not include over-the-counter drugs.

Additional data from the 2008 NSDUH show that there
were 2.5 million persons aged 12 or older who used
psychotherapeutics nonmedically for the first time
within the past year, which averages out to around
7,000 initiates per day. This annual estimate of the
initiates of psychotherapeutics was significantly
lower than the 2004 estimate (2.8 million).

Each year, the
Monitoring the Future (MTF) study asks drug use
and related questions of 8th, 10th, and 12th graders
nationwide. MTF provides usage estimates for
alcohol, tobacco, illegal drugs, and substances that
are only legally available by prescription. The
study includes data for the non-medical use of
amphetamines, stimulants including Ritalin, and
sedatives (barbiturates) including: methaqualone,
tranquilizers, the narcotic pain relievers Vicodin
and OxyContin, as well as GHB, Ketamine, and
Rohypnol, which is not legal for prescription in the
United States. Survey respondents were asked to
exclude from their responses any use of prescription
drugs that occurred under medical supervision.

MTF data for 2008 show that lifetime prevalence
rates for amphetamine use without a doctor's orders
were 6.8% for 8th graders, 9.0% for 10th graders,
and 10.5% for 12th graders.

Approximately 9.7% of 12th graders surveyed in 2008
reported annual (past year) use of Vicodin without a
doctor's orders.

According to data from the Bureau of Justice
Statistics, approximately 21.3% of State prisoners
and 16.9% of Federal prisoners surveyed in 2004
indicated that they abused depressants at some point
in their lives. For this report, depressants were
defined to include barbiturates, tranquilizers and
Quaalude.

Health Effects

The health risks associated with prescription drug
abuse vary depending on the drug. For example, abuse
of opioids, narcotics and pain relievers can slow or
stop breathing. The abuse of depressants, including
benzodiazepines and other tranquilizers,
barbiturates and other sedatives, can result in
seizure, respiratory depression and decreased heart
rate. Stimulant abuse can lead to high body
temperature, irregular heart rate, cardiovascular
system failure and seizure.9 Inappropriate use of
prescription drugs, including use without a
prescription or medical supervision, or using in a
manner other than exactly as prescribed, can lead to
addiction in some cases.

The
Drug Abuse Warning Network (DAWN) receives
reports of emergency department (ED) episodes
involving the non-medical use of legal drugs. These
can involve the deliberate abuse of prescribed or
legally obtained over-the-counter (OTC) medications
or of pharmaceuticals diverted for abuse. Accidental
overdoses or adverse reactions to OTC or
prescription drugs taken as directed are not
reportable to DAWN unless they are present in
combination with an illicit drug.

During 2006, there were an estimated 741,425 ED
visits that involved non-medical use of prescription
or OTC pharmaceuticals or dietary supplements. CNS
agents were involved in an estimated 373,138 ED
visits and psychotherapeutic agents were involved in
an estimated 323,999 visits.

Treatment

There is no single type of treatment which is
appropriate for individuals addicted to prescription
drugs. Treatment options must take into account the
specific type of drug used along with the needs of
the individual.

Several options are available for effectively
treating addiction to prescription opioids and are
drawn from research regarding the treatment of
heroin addiction. Options include medications, such
as naltrexone, methadone, and buprenorphine, as well
as behavioral counseling.

Patients addicted to barbiturates or benzodiazepines
should not attempt to stop taking the drugs on their
own, as withdrawal from these drugs can be
problematic, and in the case of certain CNS
depressants, potentially life-threatening. Patients
addicted to these medications should undergo
medically supervised detoxification because the
treatment dose must be gradually tapered. Inpatient
or outpatient counseling can help the individual
during this process. Cognitive-behavioral therapy
has also successfully been used to help individuals
adapt to the removal from benzodiazepines.

Treatment of addiction to prescription stimulants is
often based on behavioral therapies that have proven
effective in treating cocaine or methamphetamine
addiction. Depending on the patient's situation, the
first steps in treating prescription stimulant
addiction may be tapering off the drug's dose and
attempting to treat withdrawal symptoms. The
detoxification process could then be followed by one
of many behavioral therapies.

According to the Treatment Episode Data Set (TEDS),
opiates other than heroin (“other
opiates/synthetics”) accounted for 5% of the total
TEDS admissions in 2007 (90,516 admissions). These
drugs include codeine, hydrocodone, hydromorphone,
meperidine, morphine, opium, oxycodone, pentazocine,
propoxyphene, tramadol, and any other drug with
morphine-like effects.

Arrests & Sentencing

There are a variety of responses to prescription
fraud that can be used by police, pharmacists, and
others to try to prevent and address this crime:

Some states have developed prescription monitoring
programs, which can help prevent and detect the
diversion and abuse of pharmaceutical controlled
substances.18 Through the Bureau of Justice
Assistance's
Harold Rogers Prescription Drug Monitoring Program,
funds are available to develop and enhance such
programs.

The illegal sale of pharmaceutical drugs using the
Internet or e-mails advertising the sale of drugs
can be reported to the following agencies:

The DEA has also launched a toll-free international
hotline (1-877-RxAbuse) to report the illegal sale
and abuse of pharmaceutical drugs. Using the
hotline, anonymous tips can be provided about the
diversion of prescription drugs into the illegal
market by individuals and suspicious Internet
pharmacies.

During FY 2004, there were 5,556 Federal drug
arrests for "other" drugs. This category of drugs
includes barbiturates, hallucinogens, opiates other
than heroin, and synthetic drugs.

According to the Drug Enforcement Administration
(DEA), there were 237 Federal arrests involving
Oxycodone during 2006. During 2005, there were 236
such arrests.

The Arrestee Drug Abuse Monitoring (ADAM) II program
is designed to gather information on drug use and
related matters from adult male offenders within 48
hours of arrest. ADAM II serves as a critical source
of data for estimating trends in drug use in local
areas, understanding the relationship between drugs
and crime, and describing drug market activity in
the adult male arrestee population in 10 U.S. sites
during 2008. Approximately 10% of adult arrestees
reported the use of opiate painkillers in four ADAM
data collection sites (Indianapolis, IN;
Minneapolis, MN; Portland, OR; and Sacramento, CA).

Production & Trafficking

Individuals illegally obtain prescription drugs
through a variety of means, such as:

Doctor shopping or other prescription fraud

Illegal online pharmacies

Theft and burglary (from residences,
pharmacies, etc.)

Receiving/purchasing from friends or family

Overprescribing (negligent or occasionally
even intentional overprescribing by physicians
or other prescribers)

A research study was conducted in 2007 on behalf of
the National Center on Addiction and Substance Abuse
(CASA) at Columbia University. A total of 210 hours
was devoted to documenting the number of Internet
sites dispensing selected prescription drugs. Using
Internet search engines and e-mail advertisements,
researchers discovered that of the 187 Internet
sites found to be selling controlled prescription
drugs during this period, 157 (84%) did not require
any prescription. Of these sites, 52 (33%) clearly
stated that no prescription was needed, 83 (53%)
offered an “online consultation” and 22 (14%) made
no mention of a prescription.

Only 30 of the 187 Internet sites found during the
2007 study required a prescription. Of these, 17
(57%) only required patients to fax a prescription,
4 (13%) required that a patient mail the
prescription and 9 (30%) indicated that a doctor
would be contacted prior to dispensing the drug.